You give Neuro a bad name (bad name)

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Bill_Brasky

To Bill Brasky!!!
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Please excuse this post as part of a larger existential crisis I am going through. I've read alot of V.S. Ramachandran and it has made me really interested in Neurology. I'm only an (O)MS I so this is probably premature to be wondering about this sort of thing but I'm trying to use the thought of a residency to provide motivation for improving my mediocre grades.

So I was wondering about Neuro. It seems really cool because the brain is the last frontier of medicine. However, its also an organ that gives the impression of being next to impossible to meaningfully fix without massive Neurosurg-type cutting. It seems to have a rep for spending most of your career telling stroke patients what is wrong with them and then Rxing them aspirin.

So why is neuro nifty cool? It must be that y'all want to spend your careers in it. What are the perks? What are the problems? What is the primary export of Poland? (Polish sausage? Seems logical....) These are the questions on my mind. Residency seems like an evil creation. I worked my ass off to get to medical school and now I have to jump through more hoops and distinguish myself again because I don't think I'll be interested in primary care unless its EM. So right now holding off the existential dread is the idea of playing with people's brains for a living. Tell me what its like....

-Bill Brasky
"Third: Brasky got his wife pregnant and she gave birth to a delicious 16 oz. steak.

Second: The afterbirth was sautéed mushrooms.

First: Brasky's family crest is a picture of a barracuda eating Neil Armstrong.

Third: Brasky is ranked 18th in the AP College Football poll.

Second: To Bill Brasky.

Together: Bill Brasky! "

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Look into Behavioral Neurology.
 
I don't understand how is it different from people having high blood pressure, and you prescirbed an antihypertensive med, or someone with DMII and you started on some oral hypoglycemic agents. Apparently your scope and understanding of neurology is still somewhat limited......not everything is amenable to surgery. In fact, what a neurosurgeon can do in treating neurological disease is somewhat limited (spine surgery, tumor resection, srugical decompression--hematoma, swollen brain, shunt placement, and less frequent and more specialized procedures like aneurysmal clippng, DBS placement etc), and they have limited role in treating most strokes, seizure, movement disorder, and essentially no role in neuromuscular disease, behavior neurology, demyelinating disease, headaches, and peripheral neuropathies. So what do you want from a neurologist? Just like many chronic medical diseases, they are not curable, and can only be managed symptomatically. People mock on neurologists as ASA pushers probably reflect only their own limited knowledge on what a neurologist can do. I can reassure you that I am not just prescribing ASA in my clinic all day long. Shadow a neurologist now, and do a sub-i in neurology as a 4th year, and try to gain some insight on neuro.
 
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I think my earlier post gave the wrong impression. I'm really more interested in personal opinions from y'all about the good and bad about the speciality. Got opinions? 'Cause I want to hear them.

-Bill Brasky
"First: I went camping with Brasky, his wife, and his daughter Debbie!

Third: Debbie Brasky?

First: Debbie Brasky. She's 7-years-old, goes about 3'5", 55 pounds. So, I'm in the back of a pickup with Bill Brasky and a live deer! Well, Brasky, he grabs the deer by the antlers, looks at it and says, "I'm Bill Brasky! Say it!" Then he squeezes the deer in such a way that a sound comes out of its mouth - "Billbrasky!" It wasn't exactly it, but it was pretty good for a deer!

Third: That's Bill Brasky!

Together: Bill Brasky!!

Fourth: I once saw him eat a whole live chicken.

First: His favorite movie is "One on One" with Robby Benson.

Fourth: Bill Brasky once gave me a videotape of him having sex with my wife, and it was the most beautiful damn thing I ever saw!

Second: I have that tape!

Guy At Bar: [ turning around ] So do I! "
 
Yes, there are many neurogical diseases with no cure. This was one once true and still is for every medical specialty before they were even specialties. So should we not go into the field to leave patients to suffer from these diseases forever? Should we send them all to Neurosurgeons...even the pregnant woman whose fetus in potential danger because its mother may go into seizure and fall onto her stomach? Or should we encourage more people to go into the field to help take part in finding more cures and taking care of those who suffer from neurological deficits and advancing the field?

Someone must take care of these patients and they must have a lot of knowledge and experience in dealing with these sort of cases. Not all of the problems that can be helped is helped by cutting them out.

Your family practice and IM docs already have their hands full and can't be expected to keep up with the current best treatments for MS and Parkinson Disease and such. They certainly can't be expected to play a huge role in research on improving every illness that they encounter in the clinical setting.

Your earlier doc was basically a FP doc, who also did a bit of everything else. As we learned more and medicine advanced, the amount of info became to overwhelming for one person to deal with.

The neurological system is just the most mysterious of all teh syestems and therefore will require much more effort and time to unravel but like every other specialty in medicine, it is moving forward is far from stagnant and we are certainly not complacent with the idea that many of our patients will die with their illness. That is my opnion.
 
Bill_Brasky said:
I think my earlier post gave the wrong impression. I'm really more interested in personal opinions from y'all about the good and bad about the speciality. Got opinions? 'Cause I want to hear them.

-Bill Brasky
"First: I went camping with Brasky, his wife, and his daughter Debbie!

Third: Debbie Brasky?

First: Debbie Brasky. She's 7-years-old, goes about 3'5", 55 pounds. So, I'm in the back of a pickup with Bill Brasky and a live deer! Well, Brasky, he grabs the deer by the antlers, looks at it and says, "I'm Bill Brasky! Say it!" Then he squeezes the deer in such a way that a sound comes out of its mouth - "Billbrasky!" It wasn't exactly it, but it was pretty good for a deer!

Third: That's Bill Brasky!

Together: Bill Brasky!!

Fourth: I once saw him eat a whole live chicken.

First: His favorite movie is "One on One" with Robby Benson.

Fourth: Bill Brasky once gave me a videotape of him having sex with my wife, and it was the most beautiful damn thing I ever saw!

Second: I have that tape!

Guy At Bar: [ turning around ] So do I! "

It's a little hard to follow your posts when they seem more occupied with the "Bill Brasky" routine from SNL - it's not your signature, because, for one, it's different in two different posts, and, two, it's not separated by the black line.
 
The problem in reading up on Dr. Ramachandran's work is that it is basically interesting 'cutting edge' aspects of neuro physiology. Different from real world neurolgy and neurosurgery.
 
matakanan said:
The problem in reading up on Dr. Ramachandran's work is that it is basically interesting 'cutting edge' aspects of neuro physiology. Different from real world neurolgy and neurosurgery.


Cool, someone actually responding to my post. So how is it different, and what are the good and bad things about real world neuro?

-Bill Brasky
"Third: You know how Brasky served three tours in 'Nam?

Fourth: Uh-huh!

Third: Well, I'm in Corpus Christi on business a month ago, and I had this eight-foot tall Asian waiter.. which made me a little curious, so I asked him his name, and sure enough it's Ho Tran Brasky!

First: To William Robert Brasky!"
 
Bill_Brasky said:
Cool, someone actually responding to my post. So how is it different, and what are the good and bad things about real world neuro?

bump
 
sorry...too lazy to reply... lots of stuff to do. Will reply when i get time.
 
edited ... duplicate entry
 
bill - i may have gotten the wrong impression, but it seems to me that you are considering neuro b/c you think that it's the next easiest thing to get into after family / primary care. I haven't read the guy that you're talking about, and I'm sure that he is exciting. I would suggest that you check out the residency programs for Neuro - they seem to offer information on the different subspecialties. Also the American Academy of Neurology offers a variety of opportunities for students ranging from scholarships to starting your own Student Interest Group in Neurology. Here is our website for our chapter at UMMC http://neurology.umc.edu/index.php?p=sign. I hope that you will take information from these places and be encouraged. good luck!
 
Thanks for the link!! I am thinking about starting a neuro interest group, only I'm not sure how much interest there will be since I'm in an Osteopathic school that usually sends 80% of its grads into primary care residencies, but I won't know until I try.

Its not that I think getting a neuro residency will be easy, I have always liked brain stuff, especially lately I can't wait till we start neuro in a week. Its more that I'm worried about my grades this first year since I'm in the bottom half of my class, though I'm changing things to make sure that gets alot better. I think I will do well on the boards, and I plan on really working my ass off on them and I do better on tests than I do on the day-to-day grind of classes. Sorry to give that impression.

I'm just trying to cast the net to get some desriptions about the day to day work of a neurologist, and what makes it exciting since I'm still a newbie and don't know anything really yet.

-Bill Brasky
 
Ramachandran has an important view on the big picture, which is what attracted me to neurology. I read a bunch of oliver sachs that got me going. Awakenings is one of the single most detailed collection of neurological case histories you'll come across and it's beautifully written.

We're entering a new age. Our knowledge is doubling every few years now. Our ability to quantify brain activity and study the structure of the brain is exploding. Right now, neurologists can actually do a lot for their patients and help people with previously horrible diseases lead meaningful, happy lives.

I'll give ya a few examples:
Epilepsy: 2/3 of patients with epilepsy are rendered seizure free in the right hands. There are over 20 medicines for epilepsy. The remaining third is worked up for alternative therapies, including epilepsy surgery, an undertaking that involves a multidisciplinary team led by the epileptologist (a specialized neurologist). Seizure focus is localized using Video-EEG. MRI data is compared to seizure localization, neurological exam, feature of seizures. Intracranial electrodes are implanted... the epileptologist maps out the motor and language and visual cortex at the bedside. In addition, seizures are captured on intracranial electrodes... X marks the spot... 70% CURE rate for lesional temporal lobe epilepsy. Surgeon cuts... epileptologist tells where to cut, who to cut, when to cut, how to cut. Patient selection is the key to successful surgical epilepsy programs.

Stroke: ASA? how bout tPA? That's just the tip of the iceberg. INterventional neurologists (YES, it is TRUE) take acute strokes to the cath lab, give intraarterial tPA to non-IV candidates. Soon, age of clot retraction, baloon angioplasty, neuroprotection. Ever been in on an acute stroke case? you have three hours from symptom onset to get the patient in, head CT, neuro exam, labs... very exciting. Someday, we may actually have a drug that does a better job.

Myasthnia Gravis: best understood autoimmune disease, best studied, highly treatable. Ever treat a myasthenic in crisis?

Now, I'm a hospital-oriented neurologist, and I like the exciting stuff. I see a lot of elderly patients who are sick systemically, and support the overall care.

Neurologists like to examine patients. The neurological examination is one of the most precise tools ever developed for bedside medicine. It was developed over the last 120 yrs by scientific inquiry.

As the population ages, the incidence of neurological disease is increasing exponentially. the role of the neurologist will be critical in the inpatient outpatient realms in the next era of medicine.

Let alone gene therapy. It will happen.

So, here's some teasers:

Neuroprosthetics: going to happen? Already happening. Cochlear implants, vagal-nerve stimulators, deep brain stimulators for parkinsons. Not enough? cortical stims for epilepsy? How's about braincomputer interface to control paralyzed limbs or exoskeletons? going to happen. Happening today.

K, nuff said. Enjoy.
 
I'm impressed. I actually picked up Awakenings at our bookstore the other day but I'll have to finish path before I'll have time to touch it. Thanks for the info, as of now Neuro is at the top of my extremely premature list of residency interests. I e-mailed Dr. Ramachandran and he e-mailed me back letting me know that some neuro residents can get to "rotate" through his lab. How cool would that be? UCSD neuro residency is my new motivation for the endless study sessions.

-Bill Brasky
 
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